Indoxyl sulfate as a biomarker of prebiotic efficacy for weight gain prevention

ABSTRACT

The present invention relates generally to the field of nutrition and health. In particular, the present invention relates to indoxyl sulfate as a biomarker in urine of the efficacy of prebiotics for the prevention of diet induced weight gain.

FIELD OF THE INVENTION

The present invention relates generally to the field of nutrition andhealth. In particular, the present invention relates to a method forpredicting and/or quantifying the response of subjects to prebiotics inthe prevention of diet induced weight gain, and to biomarkers which areuseful in such a method.

BACKGROUND OF THE INVENTION

Obesity is a major public health issue as it enhances the risk ofsuffering several chronic diseases of increasing prevalence. Obesityresults from an imbalance between energy intake and expenditure,associated with a chronic low-grade inflammation. It is known tocontribute to the risk of developing type 2 diabetes mellitus (T2DM),non-alcoholic fatty liver disease (NAFLD), cancer, osteoarthritis andcardiovascular disease (CVD). Obesity results from a complex interactionbetween genetic and environmental factors, such as a high calorie diet,and lack of physical activity and recent research has also suggestedthat the gut microbiota may play a role in the development of obesity.An unbalanced diet rich in fat and/or carbohydrate is associated withtriglyceride storage in adipose tissue, muscle, liver and the heart.Ectopic fat deposition, particularly in a central distribution, is alsothought to contribute to a range of metabolic disorders such ashypertriglyceridaemia, hypertension, high fasting glucose and insulinresistance (IR).

Gut microbes are considered to contribute to body weight regulation andrelated disorders by influencing metabolic and immune host functions.The gut microbiota as a whole improves the host's ability to extract andstore energy from the diet leading to body weight gain, while specificcommensal microbes seem to exert beneficial effects on bile salt,lipoprotein, and cholesterol metabolism. The gut microbiota and someprobiotics also regulate immune functions, protecting the host frominfections and chronic inflammation. In contrast, dysbiosis andendotoxaemia may be inflammatory factors responsible for developinginsulin resistance and body weight gain. In the light of the linkbetween the gut microbiota, metabolism, and immunity, the use of dietarystrategies to modulate microbiota composition is likely to be effectivein controlling metabolic disorders. Although so far only a fewpreclinical and clinical trials have demonstrated the effects ofspecific gut microbes and prebiotics on biological markers of thesedisorders, the findings indicate that advances in this field could be ofvalue in the struggle against obesity and its associated-metabolicdisorders (Sanz et al. 2008).

Recent data, both from experimental models and from human studies,support the beneficial effects of particular food products withprebiotic properties on energy homeostasis, satiety regulation and bodyweight gain. Together, with data in obese animals and patients, thesestudies support the hypothesis that gut microbiota composition(especially the number of bifidobacteria) may contribute to modulatemetabolic processes associated with syndrome X, especially obesity anddiabetes type 2. It is plausible, even though not exclusive, that theseeffects are linked to the microbiota-induced changes and it is feasibleto conclude that their mechanisms fit into the prebiotic effect.However, the role of such changes in these health benefits remains to bedefinitively proven. As a result of the research activity that followedthe publication of the prebiotic concept 15 years ago, it has becomeclear that products that cause a selective modification in the gutmicrobiota's composition and/or activity(ies) and thus strengthensnormobiosis could either induce beneficial physiological effects in thecolon and also in extra-intestinal compartments or contribute towardsreducing the risk of dysbiosis and associated intestinal and systemicpathologies (Roberfroid et al., 2010).

It would therefore be desirable to provide the art with a method thatallows it to identify subjects early—ideally at risk—to put on weight(e.g. for instance after initiation of a weight loss program). Inparticular, it would be desirable to provide a method for predictingand/or quantifying the response of subjects to prebiotics in theprevention of diet induced weight gain, especially at an early stageafter starting the administration of prebiotics.

Thus an object of the present invention is to provide a method thatallows the early stratification of subjects according to whether or notthey are likely to respond to a prebiotic-based intervention to preventhigh fat diet induced or related weight gain.

SUMMARY OF THE INVENTION

Accordingly, the present invention provides a method for predictingand/or quantifying the response of a subject to prebiotics in theprevention of diet induced weight gain, comprising determining a levelof indoxyl sulfate in a urine sample obtained from a subject that hasconsumed prebiotics, and comparing the subject's indoxyl sulfate levelto a predetermined reference value, wherein a decreased indoxyl sulfatelevel, or an absence of change in the indoxyl sulfate level, in theurine sample compared to the predetermined reference value indicatesthat the administration of prebiotics is effective in the prevention ofdiet induced weight gain in the subject.

In one embodiment, the diet is a high fat diet.

In one embodiment, the method further comprises the steps of:

a) determining the level of at least one further biomarker selected fromthe group consisting of oxaloacetate, creatinine, trimethylamine, andalpha-keto-isovalerate in the urine sample, and

b) comparing the subject's level of the at least one further biomarkerto a predetermined reference value, wherein:

(i) a decreased oxaloacetate, creatinine, and/or alpha-keto-isovaleratelevel, or an absence of change in the oxaloacetate, creatinine, and/oralpha-keto-isovalerate level, in the urine sample; and/or

(ii) an increased trimethylamine level, or an absence of change in thetrimethylamine level, in the urine sample;

compared to the predetermined reference values indicates that theadministration of prebiotics will be effective in the prevention of dietinduced weight gain in the subject.

In one embodiment, the levels of the biomarkers in the urine sample aredetermined by ¹H-NMR and/or mass spectrometry.

In one embodiment, the predetermined reference value is based on anaverage indoxyl sulfate level in urine in a control population ofsubjects consuming a high fat diet. In another embodiment, thepredetermined reference value is the indoxyl sulfate level in urine inthe subject before the prebiotics were consumed.

In one embodiment, the level of indoxyl sulfate and/or the furtherbiomarkers are determined in a urine sample obtained from the subjectafter at least three consecutive days of prebiotic consumption.Preferably the subject has consumed the prebiotics in an amount of atleast 2 g/day for this period or more.

In one embodiment, the prebiotic is selected from the group consistingof oligosaccharides, optionally containing fructose, galactose, mannose;dietary fibers, in particular soluble fibers, soy fibers; inulin; ormixtures thereof. Preferably the prebiotics are selected from the groupconsisting of fructo-oligosaccharides (FOS); galacto-oligosaccharides(GOS); isomalto-oligosaccharides; xylo-oligosaccharides; bovine milkoligosaccharides (BMOS); glycosylsucrose (GS); lactosucrose (LS);lactulose (LA); palatinose-oligosaccharides (PAO);malto-oligosaccharides (MOS); gums and/or hydrolysates thereof; pectinsand/or hydrolysates thereof; and combinations thereof.

In a preferred embodiment, the prebiotics comprisegalactooligosaccharides (GOS). In another preferred embodiment, theprebiotics comprise bovine milk oligosaccharides (BMOS), more preferablycow's milk oligosaccharides-galactooligosaccharides (CMOS-GOS). Inanother preferred embodiment the prebiotics comprise inulin andfructooligosaccharides (FOS).

In some embodiments, the subject is a mammal such as a human; anon-human species, including a primate; a livestock animal such as asheep, a cow, a pig, a horse, a donkey, or a goat; a laboratory testanimal such as a mouse, rat, rabbit, guinea pig, or hamster; or acompanion animal such as a dog or a cat.

In one embodiment, the method is used to devise a stratified diet for agroup of subjects or a personalized diet for the subject.

In a further aspect, the present invention provides a method forpreventing diet-induced weight gain in a subject, comprising:

a) performing a method as described above; and

b) administering prebiotics to the subject if the level of indoxylsulfate in the urine sample is decreased or unchanged compared to thepredetermined reference value.

In one embodiment, administration of prebiotics to the subject iscontinued for at least one month.

In one embodiment, if the level of indoxyl sulfate in the urine sampleis increased compared to the predetermined reference sample, prebioticsare not administered to the subject. Preferably an alternative treatmentfor weight gain prevention is provided to the subject, the treatmentselected from calorie restriction, dietary fat intake reduction, anon-prebiotic weight loss product, or an exercise program.

In a further aspect, the present invention provides a biomarker in urinefor predicting and/or quantifying the response of subjects to prebioticsin the prevention of diet induced weight gain, wherein the biomarker isindoxyl sulfate.

In a further aspect, the present invention provides use of indoxylsulfate as a biomarker in urine for predicting and/or quantifying theresponse of subjects to prebiotics in the prevention of diet inducedweight gain.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1: Graph describing body weight curves for animals

FIG. 2: Time dependent profiles of metabolites with specific responsewith prebiotic & related to weight gain. A: Controls; B: High FatControls, C: High fat GOS; D: High fat GOSCMOS, E: High fat Prebio1, F:High fat sugars. Vertical axis corresponds to the relative concentrationin the metabolites as obtained by peak area integration, the data aregiven as area under the curve (AUC).

FIG. 3: Time dependent profiles of metabolites with specific responsewith prebiotic & related to weight gain. TMA, trimethylamine, TMAO,Trimethylamine-N-Oxide. A: Controls; B: High Fat Controls, C: High fatGOS; D: High fat GOSCMOS, E: High fat Prebio1, F: High fat sugars.Vertical axis corresponds to the relative concentration in themetabolites as obtained by peak area integration, the data are given asarea under the curve (AUC).

DETAILED DESCRIPTION OF THE INVENTION

The present inventors have used a metabonomics approach to achieve theobjective of the present invention. Metabonomics is used to characterizethe metabolic phenotype, which comprises the influence of variousfactors such as environment, drugs, dietary, lifestyle, genetics, andmicrobiome factors. Unlike gene expression and proteomic data thatindicate the potential for physiological changes, metabolites and theirdynamic concentration changes within cells, tissues and organs,represent the real end-points of physiological regulatory processes.

It is therefore a suitable approach to investigate the gradual metabolicchanges linked to various dietary interventions and diseasesdevelopment. Recently, metabolomics and lipidomics-based discoverieshave been accelerating our understanding of disease processes, and willprovide novel avenues for prevention and nutritional management of thesub-clinical disorders associated to metabolic syndrome. In particular,“omics” data have highlighted the contribution of energy metabolism(Krebs's cycle), lipid and amino acid processing, as well asinflammatory signals to the onset of obesity and IR.

Using a combination of proton nuclear magnetic resonance (¹H NMR)spectroscopy of urine samples collected overtime and weight gainmonitoring, the inventors have identified novel metabolic biomarkersindicative of the efficacy of prebiotic intervention for weight gainprevention in a well defined C57BL/6 mouse model of diet inducedobesity. The present inventors have characterised the gradual (e.g. on aweekly basis for a period of 13 weeks) metabolic adaptation of C57BL/6mice fed with a high fat diet (HFD) with and without prebiotics usingisocaloric diets. The inventors have established the specific metabolicsignatures associated with gradual obesity development under differentnutritional conditions, and phenotype variability within body weightgain dynamics.

By using a metabonomic approach, the inventors have shown thatmitochondrial metabolic pathways (fatty acid β oxidation, branched-chainamino acid catabolism, butanoate metabolism, Nicotinamide AdenineDinucleotide pathway and Krebs's cycle) are quickly up-regulated by highfat feeding which might reflect a fatty acid saturation of mitochondriaand an impairment of energy metabolism. In addition, the metabonomicanalysis showed a significant remodelling of gut microbial metabolism,as observed through changes in methylamines, dietary carbohydrate andprotein fermentation.

The inventors could show that body weight gain was prevented in thegroups of animals receiving a prebiotics-based intervention, and thatthe metabolic signatures associated to the difference in the body weightphenotype are associated with a specific modulation of high fat inducedobesity dependent biological processes, including mitochondrialoxidative pathways (fatty acid β oxidation) and gut bacterial metabolism(methylamines, dietary carbohydrate and protein fermentation).

In particular, in the experiments described herein, mice fed with a HFDand prebiotics (GOS, CMOS-GOS and inulin/FOS) displayed a urinarydecrease in indoxyl sulfate over time. The urinary decrease in indoxylsulfate is strongly correlated with resistance to weight gain in theHFD-fed mice.

These results emphasize the role of mitochondria and gut microbiota inobesity development and show that the likelihood to respond beneficiallyto prebiotics in the prevention of diet induced weight gain can bedetermined from an early metabolic signature using a specific set ofbiomarkers defined herein.

The inventors were able to show that the urine metabolic response afterone week on high fat feeding with any of the prebiotics (Day 7) enablesthe prediction of the final body weight gain for each individual (Day70). The present method therefore allows the prediction and/orquantification of the response of animals to the dietary intervention atan early stage after initiation of prebiotic administration.

Predicting and/or Quantifying the Response of a Subject to Prebiotics

In one aspect, the present invention relates to a method of predictingand/or quantifying the response of a subject to prebiotics in theprevention of diet induced weight gain in the subject.

For instance, in one embodiment the method may be used to predictwhether future or ongoing administration of prebiotics is likely to beeffective in preventing weight gain. The method may thus be used, forexample, to provide an indication of whether to continue with aprebiotic treatment for the prevention of weight gain, or whether toswitch the subject to an alternative treatment scheme.

In an alternative embodiment, the method may be used to determine orquantify the effect of prior consumption of prebiotics by the subject.For instance the method may be used to provide an indication of whetherprebiotic administration has prevented weight gain, in particular wherethis cannot be determined simply by determining the subject's weight.For example, within a specified test period it may not be known whetherthe subject would have gained or lost weight in the absence of prebioticadministration, particularly if the calorific value of the subject'sdiet is variable and/or unknown.

Subject

The method of the present invention may be carried out in subjects ofany weight, in order to predict the efficacy of prebiotics in preventingdiet-induced weight gain. Thus the subject may be an underweight,normal, overweight or an obese subject.

In particular in underweight, overweight or in obese subjects the methodof the present invention may elucidate the genetic and metabolicpredisposition of the subject towards weight gain. Based thereon, andideally under further consideration of their general health status andlifestyle, personalized nutritional regimens may be developed that canhelp to maintain or regain a healthy status.

In one embodiment the subject to be tested is susceptible todiet-induced weight gain, particularly in the absence of prebiotictreatment. For instance, the subject may be an overweight or obesesubject, for whom prebiotic administration is indicated in order toprevent weight gain. In some embodiments, the subject may be consuming ahigh fat diet, or a high calorie diet.

“Overweight” is defined for an adult human as having a BMI between 25and 30. “Body mass index” or “BMI” means the ratio of weight in kgdivided by the height in metres, squared. “Obesity” is a condition inwhich the natural energy reserve, stored in the fatty tissue of animals,in particular humans and other mammals, is increased to a point where itis associated with certain health conditions or increased mortality.“Obese” is defined for an adult human as having a BMI greater than 30.“Normal weight” for an adult human is defined as a BMI of 18.5 to 25,whereas “underweight” may be defined as a BMI of less than 18.5.

A high fat diet may be defined as a diet from which the subject derivesmore than about 20% of its total calories from fat. In some embodiments,the high fat diet may contain more than about 30% of its total caloriesin fat. In other embodiments, the subject may derive more than about 40%of its total calories from fat.

Thus the actual fat content of a high fat diet may vary depending on theoverall calorific value of the diet, as well as the gender, age,physical activity level, build, height and weight of the subject, forexample. Typically for a 70 kg man with a moderate level of physicalactivity and a daily calorie intake of 2,700 kcal, a high fat diet maybe considered to be the consumption of greater than 60 g fat per day(approximately 540 kcal energy value). Alternatively, a high fat diet insuch a subject may be defined as in excess of 90 g fat/day (810kcal/day) or 120 g fat/day (1080 kcal/day).

A high calorie diet may be defined as the consumption by the subject ofgreater than a recommended daily calorific intake, based for example onthe gender, age, physical activity level, build, height and/or weight ofthe subject. For instance, a high calorie diet for a typical 70 kg manmay be defined as the consumption of greater than 2,700 kcal/day,greater than 3,000 kcal/day, or greater than 3,500 kcal/day. For women,a high calorie diet may contain greater than 2,100 kcal/day, greaterthan 2,500 kcal/day, or greater than 3,000 kcal/day.

The subject tested in the method of the present invention has consumedprebiotics. Typically the subject has consumed prebiotics as part of aprescribed weight management program. For instance, a defined dose ofprebiotics may be administered or supplied to the subject as a dietarysupplement, in order to prevent weight gain.

Preferably the subject has consumed prebiotics for a period of at leastone day, two days, three days, one week, two weeks, one month, twomonths or three months before the sample to be tested is obtained. Inpreferred embodiments, the sample is obtained between 3 and 14 daysafter initiating consumption of prebiotics, e.g. around 7 days afterbeginning prebiotic treatment. For instance, in some embodiments thesubject has consumed prebiotics in an amount of at least 1 g/day, atleast 2 g/day, at least 5 g/day or at least 10 g/day for the perioddefined above.

In one embodiment, the subject is a human. However, the method of thepresent invention is not limited to humans. It may also be used innon-human animals, for example in companion animals such as cats ordogs. Based thereon nutritional regimens may be designed that willcontribute to a long life of the companion animal in good health.

In some embodiments, the subject is an infant or young child. The term“infant” refers to a child under the age of 12 months. The expression“young child” refers to a child aged between one and three years, alsocalled a toddler. The infant can be a term or a preterm infant. A“preterm” or “premature” infant refers to an infant that was not born atterm. Generally it refers to an infant born prior 36 weeks of gestation.In some embodiments the infant may be born by C-section, and/or a smallfor gestational age infant and/or a low birth weight infant. An “infantborn by C-section” means an infant which was delivered by Caesareansection, i.e. an infant which was not vaginally delivered.

Prebiotics

A prebiotic is a non-digestible food ingredient than beneficiallyaffects the host by selectively stimulating the growth and/or activityof one or a limited number of bacteria in the colon, and thus improveshost health. Such ingredients are non-digestible in the sense that theyare not broken down and absorbed in the stomach or small intestine andthus pass intact to the colon where they are selectively fermented bythe beneficial bacteria.

Examples of prebiotics include certain oligosaccharides, such asfructooligosaccharides (FOS), galactooligosaccharides (GOS),isomalto-oligosaccharides, xylo-oligosaccharides, BMOs (bovine's milkoligosaccharide), glycosylsucrose (GS), lactosucrose (LS), lactulose(LA), palatinose-oligosaccharides (PAO), malto-oligosaccharides (MOS),gums and/or hydrolysates thereof, pectins and/or hydrolysates thereof,and any mixtures thereof. The BMOs can be selected from the listcomprising N-acetylated oligosaccharides, sialylated oligosaccharidesand any mixtures thereof. The BMOs can be “CMOS-GOS” (cow's milkoligosaccharides-galactooligosaccharides).

A combination of prebiotics may be used such as 90% GOS with 10% shortchain fructo-oligosaccharides such as the product sold under thetrademark Raftilose® or 10% inulin such as the product sold under thetrademark Raftiline®.

A particularly preferred prebiotic is a mixture ofgalacto-oligosaccharide(s), N-acetylated oligosaccharide(s) andsialylated oligosaccharide(s) in which the N-acetylatedoligosaccharide(s) comprise (represent) 0.5 to 4.0% of theoligosaccharide mixture, the galacto-oligosaccharide(s) comprise(represent) 92.0 to 98.5% of the oligosaccharide mixture and thesialylated oligosaccharide(s) comprise (represent) 1.0 to 4.0% of theoligosaccharide mixture. This mixture is hereinafter referred to as“CMOS-GOS”. Preferably, a composition for use according to the inventioncontains from 2.5 to 15.0 wt % CMOS-GOS on a dry matter basis with theproviso that the composition comprises at least 0.02 wt % of anN-acetylated oligosaccharide, at least 2.0 wt % of agalacto-oligosaccharide and at least 0.04 wt % of a sialylatedoligosaccharide. WO2006087391 and WO2012160080 provide some examples ofproduction of “CMOS-GOS”.

“N-acetylated oligosaccharide” means an oligosaccharide having anN-acetyl residue. Suitable N-acetylated oligosaccharides includeGalNAcα1,3Galβ1,4Glc and Galβ1,6GalNAcα1,3Galβ1,4Glc. The N-acetylatedoligosaccharides may be prepared by the action of glucosaminidase and/orgalactosaminidase on N-acetyl-glucose and/or N-acetyl galactose.Equally, N-acetyl-galactosyl transferases and/or N-acetyl-glycosyltransferases may be used for this purpose. The N-acetylatedoligosaccharides may also be produced by fermentation technology usingrespective enzymes (recombinant or natural) and/or microbialfermentation. In the latter case the microbes may either express theirnatural enzymes and substrates or may be engineered to producerespective substrates and enzymes. Single microbial cultures or mixedcultures may be used. N-acetylated oligosaccharide formation can beinitiated by acceptor substrates starting from any degree ofpolymerisation (DP) from DP=1 onwards. Another option is the chemicalconversion of keto-hexoses (e.g. fructose) either free or bound to anoligosaccharide (e.g. lactulose) into N-acetylhexosamine or anN-acetylhexosamine containing oligosaccharide as described in Wrodnigg,T. M.; Stutz, A. E. (1999) Angew. Chem. Int. Ed. 38:827-828.

“Galacto-oligosaccharide” means an oligosaccharide comprising two ormore galactose molecules which has no charge and no N-acetyl residue.Suitable galacto-oligosaccharides include Galβ1,6Gal, Galβ1,6Galβ1,4GlcGalβ1,6Galβ1,6Glc, Galβ1,3Galβ1,3Glc, Galβ1,3Galβ1,4Glc,Galβ1,6Galβ1,6Galβ1,4Glc, Galβ1,6Galβ1,3Galβ1,4GlcGalβ1,3Galβ1,6Galβ1,4Glc, Galβ1,3Galβ1,3Galβ1,4Glc, Galβ1,4Galβ1,4Glcand Galβ1,4Galβ1,4Galβ1,4Glc. Synthesised galacto-oligosaccharides suchas Galβ1,6Galβ1,4Glc Galβ1,6Galβ1,6Glc, Galβ1,3Galβ1,4Glc,Galβ1,6Galβ1,6Galβ1,4Glc, Galβ1,6Galβ1,3Galβ1,4Glc andGalβ1,3Galβ1,6Galβ1,4Glc, Galβ1,4Galβ1,4Glc and Galβ1,4Galβ1,4Galβ1,4Glcand mixtures thereof are commercially available under the trade marksVivinal® and Elix'or®. Other suppliers of oligosaccharides are DextraLaboratories, Sigma-Aldrich Chemie GmbH and Kyowa Hakko Kogyo Co., Ltd.Alternatively, specific glycoslytransferases, such asgalactosyltransferases may be used to produce neutral oligosaccharides.

“Sialylated oligosaccharide” means an oligosaccharide having a sialicacid residue with associated charge. Suitable sialylatedoligosaccharides include NeuAca2,3Galβ1,4Glc and NeuAca2,6Galβ1,4Glc.These sialylated oligosaccharides may be isolated by chromatographic orfiltration technology from a natural source such as animal milks.Alternatively, they may also be produced by biotechnology using specificsialyltransferases either by enzyme based fermentation technology(recombinant or natural enzymes) or by microbial fermentationtechnology. In the latter case microbes may either express their naturalenzymes and substrates or may be engineered to produce respectivesubstrates and enzymes. Single microbial cultures or mixed cultures maybe used. Sialyl-oligosaccharide formation can be initiated by acceptorsubstrates starting from any degree of polymerisation (DP) from DP=1onwards.

In a particular preferred embodiment, the prebiotics comprisegalactooligosaccharides (GOS). In another particularly preferredembodiment, the prebiotics comprise bovine milk oligosaccharides (BMOS),more preferably cow's milk oligosaccharides-galactooligosaccharides(CMOS-GOS). In another preferred embodiment the prebiotics compriseinulin and fructooligosaccharides (FOS).

Sample

The present method comprises a step of determining the level of indoxylsulfate in a urine sample obtained from a subject.

Thus the present method is typically practiced outside of the human oranimal body, i.e. on a body fluid (urine) sample that was previouslyobtained from the subject to be tested. Using urine as the body fluid tobe tested has the advantage that it can be obtained regularly andnon-invasively using a well-established procedure. The sample can alsobe obtained without the support of medical personnel.

Determining a Level of Indoxyl Sulfate in the Sample

The level of indoxyl sulfate in the sample can be detected andquantified by any means known in the art. For example, ¹H-NMR, massspectroscopy, e.g, UPLC-ESI-MS/MS, may be used. Other methods, such asother spectroscopic methods, chromatographic methods, labelingtechniques, or quantitative chemical methods may be used as well.Preferably the indoxyl sulfate level in the sample and the referencevalue are determined by the same method.

Comparing the Indoxyl Sulfate Level to a Reference Value

The present method further comprises a step of comparing the subject'sindoxyl sulfate level to a predetermined reference value.

The predetermined reference value may be based on an average indoxylsulfate level in the tested body fluid in a control population, e.g. apopulation which has not consumed prebiotics. The control population canbe a group of at least 3, preferably at least 10, more preferably atleast 50 people with a similar genetic background, age and healthstatus. Preferably the control population is a group of subjects whohave consumed a similar diet to the subject to be tested, except inrelation to prebiotics. Typically subjects in the control populationhave consumed a high fat diet, but have consumed no prebiotics or alevel of prebiotics which is lower than that of the subject to betested.

In another embodiment, the predetermined reference value is the indoxylsulfate level in urine in the subject to be tested before the prebioticswere consumed. Thus the method may comprise monitoring a change inindoxyl sulfate levels in urine in the subject in response toconsumption of prebiotics. For instance, in one embodiment a urinesample may be obtained from a subject in order to provide a referencevalue for the level of indoxyl sulfate, after which prebiotic treatmentis initiated. Subsequently a further (test) urine sample may be obtainedafter a defined period of prebiotic consumption, as discussed above. Theindoxyl sulfate level in the test sample is then compared to thereference sample in order to determine whether indoxyl sulfate levels inthat subject have increased or decreased in response to the prebiotictreatment.

Determining Prebiotic Efficacy Based on Comparison of Indoxyl SulfateLevels

In the present method, a decreased indoxyl sulfate level, or an absenceof change in the indoxyl sulfate level, in the urine sample compared tothe predetermined reference value indicates that the administration ofprebiotics is effective in the prevention of diet induced weight gain.For example, the relative indoxyl sulfate levels in the test sample andreference sample may indicate whether prior consumption of prebioticshas been effective in preventing diet-induced weight gain, and/orwhether further administration of prebiotics will be effective inpreventing diet-induced weight gain.

In some embodiments, an decrease in the indoxyl sulfate level in theurine sample compared to the predetermined reference value is indicativeof prebiotic efficacy. In particular, in embodiments where the referencevalue is based on an average indoxyl sulfate level urine in a controlpopulation of subjects consuming a high fat diet, the indoxyl sulfatelevel in the test sample is preferably decreased compared to thereference value. Also in embodiments where the reference value is basedon the indoxyl sulfate level in urine in the subject before theprebiotics were consumed, the indoxyl sulfate level in the test sampleis preferably decreased compared to the reference value.

Preferably the indoxyl sulfate level in the urine sample is decreased byat least 1%, 5%, at least 10%, at least 20%, at least 30%, or at least50% compared to the predetermined reference value.

In other embodiments, an absence of change in the indoxyl sulfate levelin the urine sample compared to the predetermined reference value may beindicative of prebiotic efficacy. For instance, in some embodiments thefat content and/or calorific value of the subject's diet may bevariable. For instance, the fat content and/or calorific value of thesubject's diet may increase between a time at which a control sample istaken to determine the reference value, and a later time at which thetest sample is taken. In such embodiments, an absence of change in theindoxyl sulfate level in the test urine sample compared to thepredetermined reference value may also be indicative of prebioticefficacy.

Preferably an “absence of change in the indoxyl sulfate level” means adifference of less than 10%, less than 5%, less than 4%, less than 3%,less than 2% or less than 1% between the indoxyl sulfate level in theurine sample and the predetermined reference value.

Since in embodiments of the present invention a non-increased indoxylsulfate level in the urine sample compared to the predeterminedreference value indicates that the administration of prebiotics iseffective in the prevention of diet induced weight gain, an increasedlevel of indoxyl sulfate in the urine sample compared to thepredetermined reference values may indicate that administration ofprebiotics is less likely to be effective in the prevention of high fatdiet induced weight gain. For instance, an increased level of indoxylsulfate in the urine sample compared to the reference value may indicatethat prior consumption of prebiotics has not been effective inpreventing diet-induced weight gain, and/or that further administrationof prebiotics will be ineffective in preventing diet-induced weightgain.

Further Biomarkers

In the present method, further biomarkers can also be used forpredicting and/or quantifying the response of the subject to prebioticsin the prevention of diet induced weight gain.

As such the inventors have identified that non-increased urineconcentrations of oxaloacetate, creatinine, and/oralpha-keto-isovalerate level allow the diagnosis of an increasedlikelihood to resist high fat diet induced weight gain. Furthermore, thepresent inventors have shown that an increased urine concentration oftrimethylamine in urine is indicative of prebiotic efficacy in theprevention of diet induced weight gain

The method of the present invention may, therefore, further comprise thesteps of determining the level of at least one further biomarkerselected from the group consisting of oxaloacetate, trimethylamine,creatinine, and alpha-keto-isovalerate in the urine sample, andcomparing the subject's level of the at least one further biomarker to apredetermined reference value, wherein (i) a decreased oxaloacetate,creatinine, and/or alpha-keto-isovalerate level, or an absence of changein the oxaloacetate, creatinine, and/or alpha-keto-isovalerate level, or(ii) an increased trimethylamine level, or an absence of change in thetrimethylamine level, in the urine sample compared to the predeterminedreference values indicates that the administration of prebiotics iseffective in the prevention of diet induced weight gain in the subject.

The further biomarkers may also be detected and quantified by ¹H-NMR ormass spectroscopy, e.g., UPLC-ESI-MS/MS. Other methods, such as otherspectroscopic methods, chromatographic methods, labeling techniques, orquantitative chemical methods may be used as well.

Preferably all of the biomarkers to be determined are assessed by thesame technology. In some embodiments all of the tested biomarkers areassessed simultaneously.

The method of the present invention may comprise the assessment of atleast 2, at least 3, at least 4, or at least 5 biomarkers as mentionedabove.

For example, indoxyl sulfate may be assessed together with oxaloacetate.

Indoxyl sulfate may also be assessed together with trimethylamine.

Indoxyl sulfate may also be assessed together with creatinine.

Indoxyl sulfate may also be assessed together withalpha-keto-isovalerate.

Indoxyl sulfate may also be assessed together with oxaloacetate andtrimethylamine.

Indoxyl sulfate may also be assessed together with oxaloacetate andcreatinine.

Indoxyl sulfate may also be assessed together with oxaloacetate andalpha-keto-isovalerate.

Indoxyl sulfate may also be assessed together with trimethylamine andcreatinine.

Indoxyl sulfate may also be assessed together with trimethylamine andalpha-keto-isovalerate.

Indoxyl sulfate may also be assessed together with creatinine andalpha-keto-isovalerate.

Indoxyl sulfate may also be assessed together with oxaloacetate,trimethylamine and creatinine.

Indoxyl sulfate may also be assessed together with oxaloacetate,trimethylamine and alpha-keto-isovalerate.

Indoxyl sulfate may also be assessed together with oxaloacetate,creatinine, and alpha-keto-isovalerate.

Indoxyl sulfate may also be assessed together with creatinine,trimethylamine, and alpha-keto-isovalerate.

Indoxyl sulfate may also be assessed together with oxaloacetate,trimethylamine, creatinine, and alpha-keto-isovalerate.

The advantage of assessing more than one biomarker is that the morebiomarkers are evaluated the more reliable the diagnosis may become. Forinstance, if more than 1, 2, 3, 4 or 5 biomarkers are increased ordecreased in level between the urine sample and the correspondingpredetermined reference values, this may be more strongly indicative ofwhether or not prebiotics are likely to be effective in the preventionof diet induced weight gain in the subject.

The reference value for indoxyl sulfate and optionally for the furtherbiomarkers is preferably measured using the same units used tocharacterize the level of indoxyl sulfate and optionally the furtherbiomarkers obtained from the test subject. Thus, if the level of indoxylsulfate and optionally the other biomarkers is an absolute value (e.g.the units of indoxyl sulfate are measured in μmol/l (μM)) the referencevalue is also preferably measured in the same units (e.g. μmol/l (μM)indoxyl sulfate in individuals in a selected control population ofsubjects or in the subject before administration of prebiotics).

The reference value can be a single cut-off value, such as a median ormean. Reference values of indoxyl sulfate and optionally the furtherbiomarkers in obtained urine samples, such as mean levels, medianlevels, or “cut-off” levels, may be established in some embodiments byassaying a large sample of individuals in the general population or theselected population (e.g. individuals consuming a high fat diet). Astatistical model, such as the predictive value method, may be used forselecting a positivity criterion or receiver operator characteristiccurve that defines optimum specificity (highest true negative rate) andsensitivity (highest true positive rate) as described in Knapp, R. G.,and Miller, M. C. (1992). Clinical Epidemiology and Biostatistics,William and Wilkins, Harual Publishing Co. Malvern, Pa., which isincorporated herein by reference. The reference values for comparison inrelation to a specific subject and biomarker may be selected accordingto the gender, race, genetic heritage, health status or age of thesubject, for example.

Preventing Diet-Induced Weight Gain

In one aspect, the present invention provides a method for preventingdiet-induced weight gain in a subject. The method may compriseperforming a method as described above in order to determine prebioticefficacy in the subject, and subsequently administering prebiotics ornot depending on whether the method indicates that prebiotics are likelyto be effective. In this way, prebiotic treatment can be targeted atsubjects who are most likely to benefit, whereas an alternative weightgain prevention program can be developed for subjects in whom prebioticsare less likely to be effective.

In particular, the present method permits the early stratification ofsubjects, for example after a short term nutritional intervention withprebiotics. For instance the method may be performed after 1 week orless of prebiotic treatment, before the subject has put on weight whichmay result in health risks, to assess the efficacy of the interventionfor long term body weight gain prevention. By determining whether thesubject is susceptible to prebiotic based intervention to prevent dietinduced weight gain, the lifestyle and/or diet of the subject can beadjusted accordingly at an early stage of the intervention process. Thusthe method may be used in order to develop a personalized nutritionaland/or exercise regime to provide a healthy physique for the subject.

Thus in embodiments of the present method, if the level of indoxylsulfate in the urine sample is decreased or unchanged compared to thepredetermined reference value, prebiotics are administered to thesubject. Since the subject has typically already consumed prebiotics aspart of the intervention process before the testing step, this may meanthat the administration of prebiotics to the subject is continued.Optionally the levels of the further biomarkers described above may alsobe taken into account in determining whether to continue prebioticadministration.

The consumption of prebiotics by the subject may be continued in anyamount, for instance the amount of prebiotics consumed may increase,decrease or stay the same after the testing step. However, after apositive indication of prebiotic efficacy is obtained, prebiotics arepreferably administered to the subject in an amount at least equal tothat consumed before the test sample is taken, e.g. in an amount of atleast 2 g/day. The administration of prebiotics to the subject may becontinued for at least one further week, at least 2 weeks, at least 1month, at least 3 months, at least 6 months, at least 1 year orindefinitely after the determination of prebiotic efficacy.

Typically if a negative determination of prebiotic efficacy is obtained(as indicated by e.g. an increased indoxyl sulfate level, and optionallya decreased trimethylamine level and/or an increased level of one ormore of the other biomarkers defined above), prebiotics are notadministered to the subject. This may mean that prebiotic administrationto the subject is discontinued, or at least not further prescribed tothe subject as part of a managed nutritional regime. Typically in theevent of an indication of lack of efficacy of prebiotics, prebioticconsumption by the subject may be decreased by at least 50%, at least75% or at least 90% compared to the amount of prebiotics consumed beforethe test sample is taken. For instance, in some embodiments the subjectmay consume prebiotics in an amount of less than 2 g/day, less than 1g/day, or less than 0.5 g/day after prebiotics are found to beineffective.

In preferred embodiments, if the method indicates that prebiotics arelikely to be ineffective then an alternative weight management strategymay be adopted for the subject. For instance, for such subjects it maybe more beneficial to focus on well-established weight gain preventionmethods such as dietary calorie restriction, dietary fat intakereduction or increased exercise. In other embodiments an alternative(non-prebiotic) weight loss product may be administered to the subject.

Preventing Obesity-Related Disorders

In some embodiments, an increased likelihood to respond to prebiotics inthe prevention of diet induced weight gain may be indicative of adecreased risk of developing disorders associated with obesity and/orbeing overweight. Disorders associated with excess weight and/or obesitymay be cardiovascular conditions such as atherosclerosis, stroke andheart disease and/or metabolic deregulations including diabetes. Inparticular, the risk of developing such weight-related conditions may bedecreased in subjects who are both responsive to prebiotics and whocontinue to consume prebiotics in the long term, for instance as part ofa managed nutritional regime. Conversely, subjects who are shown to benon-responsive to prebiotics in the prevention of weight gain may be atparticular risk of developing these conditions, and require further oralternative nutritional or lifestyle-based interventions.

Further Aspects

In a further aspect, the present invention provides indoxyl sulfate as anovel biomarker in urine of prebiotic efficacy in the prevention of dietinduced weight gain.

The invention also provides the use of indoxyl sulfate as a biomarker inurine for predicting and/or quantifying the response of subjects toprebiotics in the prevention of diet induced weight gain.

The study presented in this application provides an insight into thephysiological mechanisms related to HF (high fat) induced obesitydevelopment and particularly highlights the specific metabolicadaptations associated to obese phenotype variability. The study alsoinvestigated, using isocaloric and carbohydrate match-content, the roleof dietary soluble fibers on diet induced weight gain.

High fat ingestion provokes a rapid and consistent up-regulation ofmitochondrial metabolic pathways resulting in more production of energyand increased mitochondrial fatty acid saturation. The metabolicsignatures associated to the difference in the body weight phenotype areassociated with a specific modulation of high fat induced obesitydependent biological processes, including mitochondrial oxidativepathways (fatty acid β oxidation) and gut bacterial metabolism(methylamines, dietary carbohydrate and protein fermentation).

Body weight gain was prevented in the groups of animals receiving any ofthe prebiotics based intervention, with a specific modulation ofmetabolic signatures ascribed to diet induced weight gain. The modulatedmetabolic signatures enabled an accurate prediction of final body weightgain and therefore the assessment of the efficacy of prebiotics toprevent weight gain.

The present inventors showed that the observed metabolic signature afteronly one week of intervention enables the prediction of final bodyweight gain at the end of the long term intervention (70 days). Theseresults emphasize the role of mitochondria and gut microbiota in obesitydevelopment and indicate that responsiveness to prebiotics in theprevention of diet induced weight gain can be determined from an earlymetabolic signature using the biomarkers described herein.

The metabolic signature encapsulates contributions from both host energymetabolism and gut microbiota metabolic features. Consequently, thiscomprehensive analysis of the mechanisms underlying heterogeneousadaptation to high fat feeding provides novel and promising perspectivesfor weight management programs and personalized nutritional solutions.

The invention will now be described by way of example only with respectto the following specific embodiments.

EXAMPLES Animal Handling Procedure and Sample Preparation

The experiment was carried out under appropriate national guidelines atthe Nestle Research Center (NRC, Switzerland). The mice were maintainedin individual cage under 12 h-12 h of light-dark regime and fed adlibitum during the overall experiment. After a period of acclimatizationof three weeks on low fat diet (Research Diets, USA), the animals wereswitched to one of the following treatments, whilst one control groupwill be kept on low fat diets. A total of 90 C57BL/6 mice firstlyreceived a standard chow diet for three weeks. Animals were randomizedbased on fasting blood glucose and body weight gain. At day 0, mice werethen split in 6 groups of 15 animals, one group received a standard chowdiet while the other groups received a high fat diet supplemented withprebiotics or sugars.

The low fat and high fat diets were obtained from standard low and highfat diets from Research Diets, USA, and were isocaloric (4057 Kcal/Kg):

Diet D09072901i is a Rodent Diet With 60 kcal % Fat

Diet D09072902i is a Rodent Diet With 60 kcal % Fat and 211 g Fiber MixA

Diet D09072903i is a Rodent Diet With 60 kcal % Fat and 140 g Fiber MixB

Diet D09072904i is a Rodent Diet With 60 kcal % Fat and 100 g Fiber MixC

Diet D09072905i is a Rodent Diet With 60 kcal % Fat and 35.1 g Dextrose,32.3 g Lactose and 1.45 g galactose

The preparation of the diets was as described here below:

For mix A: GOS prebiotics

Add to diet 211 g of syrup or 158.2 g of dried powder, for a total of531 Kcal.

In dry matters, 90 g are fibers (258Kcal), and 68.2 gm are sugars (272.8Kcal),

To maintain isolcaloric balance between the different diets in thedifferent groups, 258Kcal were removed from Maltodextrin, and 272.8Kcalfrom sucrose.

For mix B: GOS-CMOs prebiotics

Add to diet 140 g of powder, for a total of 350 Kcal.

In dry matters, 35.7 g are fibers (71.4Kcal), and remaining 278.6Kcalare from Sugars.

To maintain isolcaloric balance between the different diets in thedifferent groups, 75Kcal were removed from maltodextrin, and 275Kcalfrom sucrose.

For mix C: Inulin and fructooligosaccharides (FOS)—Prebio 1

For 100 g product, add 30 g of product FOS to 70 gm of Inulin.

Add to diet 100 g of mix C.

In dry matters, 90 g are fibers (116Kcal), and 10 g are sugars (40Kcal).

To maintain isolcaloric balance between the different diets in thedifferent groups, 116Kcal were removed from maltodextrin, and 40Kcalfrom sucrose.

For mix D:

Mix D is composed at 51% by glucose, 47% by lactose and 2% by galactose.

Add to diet, 68.75 g of Mix D, i.e. 275Kcal. (35 gm glucose, 32.3 gmlactose, 1.45 gm galactose)

To maintain isolcaloric balance between the different diets in thedifferent groups, 275Kcal were removed from sucrose.

During the experimental study, the animals were monitored for their bodyweight and composition, food and water consumption. Difference in weightgain was assessed by non parametric test (Wilcoxon-Mann-Whitney U test).

There is a significant decrease in weight gain of animal received highfat diet in combination with prebiotics when compared to animals fed onhigh at diet of FI overtime.

Urine samples were collected on a weekly basis, namely the three weeksbefore diet switch (D-21 to D0) and 10 weeks during the nutritionalinterventions (D0 to D70). All the samples were snap-frozen at −80 Cuntil analysis.

¹H NMR Spectroscopy

A volume of 40 μl of urine were diluted in 20 μl of buffer solution(NaHPO₄, 0.6M pH=7) containing sodium azide (3 mM) and TSP (0.5 mM).After centrifugation, samples were transferred in 1.7 mm diameter NMRtubes by using a syringe. ¹H NMR spectra were then recorded on 600.13MHz spectrometer, by performing 64 scans of a standard sequence with 64Kdata-points. The temperature of NMR experiment was maintained at 300 K.Processing of urine spectra was carried out by using the softwareTOPSPIN 2.0 (Bruker Biospin, Rheinstetten, Germany). For each spectrum,the FIDs were multiplied by an exponential function corresponding to aline broadering of 1 Hz, prior to being transformed into spectrum by aFourrier Transformer. The phase and baseline of the spectra were thenmanually corrected. The chemical shift was calibrated by using the TSPsignal at δ 0.0. Spectral assignments were achieved by using STOCSY(Statistical TOtal Correlation SpectroscopY), spectral databases andpublished assignment.

Data Processing and Multivariate Data Analysis:

The spectral data (from δ 0.2 to δ 9.5) were finally imported intoMatlab software (version, the mathworks Inc, Natwick Mass.) and weretransformed into 22K data-points. Resonance of water peak (δ 4.7-5.05)was removed from each spectrum in order to eliminate the variabilitylinked to the water resonance presaturation. ¹H NMR spectra were thennormalized on total area and different multivariate statistics (PCA,OPLS, and OPLS-DA) were applied by using “unit variance” scaling.

Intermediates metabolites from host gut microbial co-metabolism, as wellas from host β oxidation, BCAAs oxidation, Krebs's cycle andNicotinamide adenine dinucleotide pathways assignable on urine ¹H NMRspectra were integrated in order to assess the urinary excretion ofthese metabolites overtime for each individual animal for each group.Data were also analysed using multivariate analysis in combination withunivariate analysis to select patterns associated with weight gain andgroup specificities.

Major Findings and Highlights:

Body Weight Gain Variability in C57BL/6J Mice Fed a HFD with or withoutPrebiotics.

Results on body weight (BW) and BW gain are very consistent. At day 7already, BWs and BW gains in most of the prebiotics groups aresignificantly lower than in the high fat group and the differenceincrease until day 70 (FIG. 1). Nevertheless at the end of the study allthe group are also significantly higher than the control group fed witha low fat diet. The time where this difference finally becomessignificant differs from a prebiotic group to the other. Prebio 1(inulin+FOS prebiotics) group is already higher on these parameters thanCtrl group at day 2 (BWG) or 35 (BW) and is very different at day 70 (BW2.81 [1.19;4.43] p=0.0023; BWG 2.46 [1.12;3.81] p=0.0013).

Urine Metabolic Profiling Points Out Sustained Metabolic SignatureAssociated to High Fat Induced Obesity

To investigate the specific metabolic signature associated withdiet-induced obesity development, we acquired urine metabolic profilesovertime over a period of 13 weeks (FIG. 1). Urine metabolic profilesfrom mice fed with a low fat, high fat and high fat diet with prebioticswere then integrated with body weight and body weight gain. Based onthis analysis using the full metabolic profiles, metabolic signaturescould be ascribed to weight gain.

Representative signals of the most influential metabolites wereintegrated and further analyses using multivariate data analysis wasconducted using data at Day 0, Day 7 and Day 70 to identified the bestearly predictors of weight gain. Each model was calculated by using onepredictive and several orthogonal components. The optimal number oforthogonal components was determined by R²Y and Q²Y goodness-of-fitstatistics (FIG. 2). A first model was generated using 35 metabolitesand then a second model was generated using the top 12 metabolites (asdefined by Variable Importance Plot, and correlation coefficient values,FIGS. 2 and 3). For each model, the confusion matrix showed a very goodmodel capacity for animal group stratification.

Metabolites with the highest correlation coefficient were identified,indicating the urinary metabolic variations encapsulates a modulation ofboth host and gut microbial metabolism. In particular, the level ofcarnitine, acylcarnitine, tricarboxylic acid metabolites, and theintermediates of branch chain amino acid oxidation were significantlycorrelated with weight gain. Conversely, the levels of methylaminederivatives produced from microbial choline metabolism (trimethylamine(TMA), and Trimethylamine (TMAO)) as well as taurine, were showingnegative relationships with weight gain. Furthermore, the end-productsof aromatic amino acid degradation by gut bacteria (phenylacetylglycine,indoxylsulfate) were also showing a positive linkage with weight gain.

Urine Metabolic Pattern of Metabolite Excretion Overtime Highlights aSpecific Metabolic Adaptation Associated to Diet Induced Weight Gain andPrevention Using Prebiotics

Application of similar data analyses for intra-group data modelling haverevealed group specificities in term of host and gut microbial metabolicadaption, which may link to the beneficial reduction in body weightgain.

In particular, the degree of variation in the urinary level of gutmicrobial co-metabolites, including TMA, TMAO, phenylacetylglycine,indoxylsulfate, suggests a time- and nutrition dependent shift in themetabolic processing of dietary component by the gut microbiota. WhereasTMA and TMAO urinary levels are significantly reduced by high fat diet,the prebiotic supplementation tend to prevent the decreased productionof TMA by the gut microbiota and further hepatic processing to TMAO. Onthe contrary, whilst indoxylsulfate and phenyacetylglycine urineconcentration tends to be slightly decreased by the high fat diet, agreater reduction is observed with prebiotic supplementation. Theseobservations taken together with the strong correlation with body weightgain, tend to illustrate that the efficacy of prebiotic modulation ofthe gut microbiota is essential to mediate the weight gain preventionbenefit.

Hence, HFD treatment may imply significant changes in gut microbiotaactivity with it either prevented with prebiotic (TMA/TMAO) orcompensated by other microbial processes such as proteolyticfermentation (phenylacetylglycine, indoxylsulfate).

In parallel, these gut microbial changes are associated with asignificant modulation of the host central energy metabolism.

The excretion of isovalerylglycine and α-ketoisovalerate significantlyand consistently increased in HFD fed group compared to LFD fed groupovertime, so they constitute qualitative and stable candidate biomarkersof DIO. Prebiotic supplementation resulted in the prevention of thesechanges, as noted with a maintenance or slight decrease in the urinarylevel of α-ketoisovalerate, and a delayed increased inisovaleroylglycine. The latter change and similar concentrations beingobserved at Day 70 across groups with and without prebiotics, suggestedthat the overweight phenotype at day 70 induce a significant change inthe energy metabolism. However, its delayed in the period of metabolicadaptation to diet switch seems to correlate with prebiotic efficacy inweight gain prevention. In addition, a similar transitory effect wasalso observed on the urinary excretion of creatinine, a well acceptedmarker of lean mass and muscle metabolism.

Moreover, the beneficial effect of prebiotics could be observed throughthe specific changes on tricarboxylic acid metabolic intermediateoxaloacetate and related tartrate, suggesting a modulation of energyproduction associated with a differential use of nutrient to fuel thebody.

Finally, some specificities were observed in relation to carnitine andacylcarnitine metabolism, with inferred effect on fatty acid oxidationand mitochondrial metabolism, with a specific stimulation of the relatedphysiological processed in animals received GOS-CMOS prebiotics.

Furthermore, in order to evaluate the relationship between earlymetabolic changes in urinary excretion of metabolites and weight gain,we calculated metabolite fold of change over the first week followingdiet switch, and compared the strength of the association to weight gainwith relative metabolite concentration and its ratio to creatinineconcentration (Table 1). The analysis showed some strong and consistentcorrelation between weight gain and the fold of change and relativeconcentration of the metabolites, including alpha-keto-isovalerate,indoxylsulfate, trimethalymine, phenylacetylglycine, oxaloacetate, andcreatinine. In addition, the fold of changes are reported after one weekand after 70 days of the high fat diet with and without prebiotics foreach group and for the body weight gain (Table 2).

The above observations on the association of specific metabolites toweight gain, their specific modulation by prebiotics, and theiridentification as early metabolic indicators of response to prebioticintervention, the biomarkers described herein allows the diagnosis ofthe likelihood to respond positively to prebiotic-based nutritionalintervention for the prevention of diet induced weight gain.

The regulation of mitochondrial metabolism in HFD fed mice waspreviously investigated using a metabonomic approach. Urinary excretionof β oxidation intermediates: hexanoylglcyine, carnitine andacylcarnitine were consistently increased in urine of HF fed micecompared to LF fed mice, which suggests an increase of fatty acidoverflow in the mictochondria and an activation of β oxidation. In thepresent study, prebiotics tend to promote a further increase in thesemetabolic processes, suggesting a more efficient oxidation of fattyacid, which is maintained over time.

Leucine, valine, isoleucine as well as intermediates of BCAAs catabolism(isovalerylglycine, α-keto-βmethylvalerate and α-ketoisovalerate) weresignificantly and consistently increased in HF fed mice supporting thehypothesis of HFD associated up-regulation of BCAAs catabolism. In thepresent study, the prebiotics tend to prevent the specific increase inisoleucine catabolism as noted with the maintenance of normal levels ofalpha-keto-iso-valerate.

Valine and isoleucine catabolism may be up-regulated in HF fed miceinducing the formation of succinyl-CoA and the production of thefollowing Krebs's cycle intermediates. Surprisingly, the other Krebs'scycle intermediates (citrate, cis-aconitase, α-ketoglutarate) were notsignificantly different between LF and HF fed mice suggesting adisconnection between leucine catabolism and beta oxidation producingacetyl-CoA, and Krebs's cycle. Specific metabolic regulations coulddivert the flux of acetyl-CoA toward other metabolic pathways. Theseresults confirm that HFD induces an up-regulation of mitochondrialoxidative pathways and Krebs's cycle which might lead to an increase ofenergy production. In the present study, prebiotics tend to induce adeep modulation of Krebs' cycle intermediates with suggests adifferential metabolism of mitochondrial oxidative pathways.

Finally, the current findings showed that prebiotic modulation of gutmicrobial activities and subsequently the further metabolism by the hostof the derived products, may be essential in mediating the benefits forweight gain. Moreover, the early metabolic adaptation to the dietchanges seems to correlate with the final acquired metabolic andanthropometric phenotype of the animals, making gut microbial relatedmetabolites key markers for future personalized weight managementnutritional solutions.

Additional Embodiments

In further aspects, the present invention provides embodiments asdescribed in the following numbered paragraphs.

1. A method for predicting and/or quantifying the response of a subjectto prebiotics in the prevention of diet induced weight gain, comprising

a) determining a level of trimethylamine in a urine sample obtained froma subject that has consumed prebiotics, and

b) comparing the subject's trimethylamine level to a predeterminedreference value,

wherein an increased trimethylamine level, or an absence of change inthe trimethylamine level, in the urine sample compared to thepredetermined reference value indicates that the administration ofprebiotics is effective in the prevention of diet induced weight gain inthe subject.

2. A method for predicting and/or quantifying the response of a subjectto prebiotics in the prevention of diet induced weight gain, comprising

a) determining a level of alpha-keto-isovalerate in a urine sampleobtained from a subject that has consumed prebiotics, and

b) comparing the subject's alpha-keto-isovalerate level to apredetermined reference value,

wherein a decreased alpha-keto-isovalerate level, or an absence ofchange in the alpha-keto-isovalerate level, in the urine sample comparedto the predetermined reference value indicates that the administrationof prebiotics is effective in the prevention of diet induced weight gainin the subject.

3. The method of paragraph 1 or paragraph 2, wherein the diet is a highfat diet.

4. The method of any preceding paragraph, further comprising the stepsof

a) determining the level of at least one further biomarker selected fromthe group consisting of trimethylamine, oxaloacetate, creatinine,indoxyl sulfate and alpha-keto-isovalerate in the urine sample, and

b) comparing the subject's level of the at least one further biomarkerto a predetermined reference value,

wherein:

(i) a decreased oxaloacetate, creatinine, indoxyl sulfate and/oralpha-keto-isovalerate level, or an absence of change in theoxaloacetate, creatinine, indoxyl sulfate and/or alpha-keto-isovaleratelevel, in the urine sample; and/or

(ii) an increased trimethylamine level, or an absence of change in thetrimethylamine level, in the urine sample;

compared to the predetermined reference values indicates that theadministration of prebiotics will be effective in the prevention of dietinduced weight gain in the subject.

5. The method according to any preceding paragraph, wherein the levelsof the biomarkers in the urine sample are determined by 1H-NMR and/ormass spectrometry.

6. The method according to any preceding paragraph, wherein thepredetermined reference value is based on an average trimethylaminelevel and/or alpha-keto-isovalerate in urine in a control population ofsubjects consuming a high fat diet.

7. The method according to any of paragraphs 1 to 5, wherein thepredetermined reference value is the trimethylamine level and/oralpha-keto-isovalerate level in urine in the subject before theprebiotics were consumed.

8. The method according to any preceding paragraph, wherein the level oftrimethylamine, alpha-keto-isovalerate and/or the further biomarkers aredetermined in a urine sample obtained from the subject after at leastthree consecutive days of prebiotic consumption.

9. The method according to any preceding paragraph, wherein theprebiotic is selected from the group consisting of oligosaccharides,optionally containing fructose, galactose, mannose; dietary fibers, inparticular soluble fibers, soy fibers; inulin; or mixtures thereof.

10. The method according to paragraph 9, wherein the prebiotics areselected from the group consisting of fructo-oligosaccharides (FOS);galacto-oligosaccharides (GOS); isomalto-oligosaccharides;xylo-oligosaccharides; bovine milk oligosaccharides (BMOS);glycosylsucrose (GS); lactosucrose (LS); lactulose (LA);palatinose-oligosaccharides (PAO); malto-oligosaccharides (MOS); gumsand/or hydrolysates thereof; pectins and/or hydrolysates thereof; andcombinations thereof.

11. The method of paragraph 10, wherein the prebiotics comprise (a)galactooligosaccharides (GOS) (b) bovine milk oligosaccharides (BMOS) or(c) inulin and fructooligosaccharides (FOS).

12. The method of paragraph 11, wherein the bovine milk oligosaccharides(BMOS) comprise cow's milk oligosaccharides-galactooligosaccharides(CMOS-GOS).

13. The method according to any preceding paragraph, wherein the subjecthas consumed the prebiotics in an amount of at least 2 g/day.

14. The method according to any preceding paragraph, wherein the subjectis a mammal such as a human; a non-human species, including a primate; alivestock animal such as a sheep, a cow, a pig, a horse, a donkey, or agoat; a laboratory test animals such as mice, rats, rabbits, guineapigs, or hamsters; or a companion animal such as a dog or a cat.

15. The method according to any preceding paragraph, wherein the methodis used to devise a stratified diet for a group of subjects or apersonalized diet for the subject.

16. A method for preventing diet-induced weight gain in a subject,comprising:

a) performing a method as described in any of paragraphs 1 to 15; and

b) administering prebiotics to the subject if (i) the level oftrimethylamine in the urine sample is increased or unchanged and/or (ii)the level of alpha-keto-isovalerate in the urine sample is decreased orunchanged, compared to the predetermined reference value.

17. A method according to paragraph 16, wherein administration ofprebiotics to the subject is continued for at least one month.

18. A method according to paragraph 16, wherein if (i) the level oftrimethylamine in the urine sample is decreased or unchanged and/or (ii)the level of alpha-keto-isovalerate in the urine sample is increased orunchanged, compared to the predetermined reference sample, prebioticsare not administered to the subject.

19. A method according to paragraph 18, wherein an alternative treatmentfor weight gain prevention is provided to the subject, the treatmentselected from calorie restriction, dietary fat intake reduction, anon-prebiotic weight loss product, or an exercise program.

20. A biomarker in urine for predicting and/or quantifying the responseof subjects to prebiotics in the prevention of diet induced weight gain,wherein the biomarker is trimethylamine.

21. A biomarker in urine for predicting and/or quantifying the responseof subjects to prebiotics in the prevention of diet induced weight gain,wherein the biomarker is alpha-keto-isovalerate.

22. Use of trimethylamine as a biomarker in urine for predicting and/orquantifying the response of subjects to prebiotics in the prevention ofdiet induced weight gain.

23. Use of alpha-keto-isovalerate as a biomarker in urine for predictingand/or quantifying the response of subjects to prebiotics in theprevention of diet induced weight gain.

Although the invention has been described by way of example, it shouldbe appreciated that variations and modifications may be made withoutdeparting from the scope of the invention as defined in the claims.Furthermore, where known equivalents exist to specific features, suchequivalents are incorporated as if specifically referred to in thisspecification. Further advantages and features of the present inventionare apparent from the figures and non-limiting examples.

Those skilled in the art will understand that they can freely combineall features of the present invention disclosed herein. In particular,features described for different embodiments of the present inventionmay be combined.

As used in this specification, the words “comprises”, “comprising”, andsimilar words, are not to be interpreted in an exclusive or exhaustivesense. In other words, they are intended to mean “including, but notlimited to”.

Any reference to prior art documents in this specification is not to beconsidered an admission that such prior art is widely known or formspart of the common general knowledge in the field.

TABLE 1 Summary of relationships between metabolites and weight gain inhigh fat induced weight gain Correlation Coefficient with Weight Gain inhigh fat fed animals (r value) Fold of change Concentration Ratiometabolite/ Metabolites (T7/T0) T7 creatinine T7 Acyl.carnitine0.158253393 0.098288017 −0.139618561 Carnitine −0.138725606 −0.129539973−0.216813487 Creatinine 0.306373827 0.402834663 Not applicableIndoxylsulfate 0.655850247 0.680973297 0.607275477 Isovalerylglycine0.153748589 0.307939099 0.005581991 Oxaloacetate 0.729067593 0.7508682850.659882916 Phenylacetylglycine 0.525457288 0.574980126 0.498217971Tartrate 0.018061809 0.273162626 0.127048017 Taurine −0.15540473−0.275405566 −0.339707993 TMA −0.235079974 −0.24950404 −0.282660746 TMAO−0.058723531 −0.208883241 −0.300038561 Alpha-keto- 0.3756282950.392090066 0.061032612 isovalerate

TABLE 2 Summary of the fold of changes in selected metabolites over timein animals fed with a high fat diet with and without prebiotics Fold ofchange Fold of change Metabolite Group (T7-T0) (T70-T0) Body weight gainLow Fat control  1.0 ± 0.0  1.1 ± 0.1 High fat control  1.1 ± 0.0  1.6 ±0.2 High fat & GOS  1.1 ± 0.0  1.2 ± 0.1 High fat &  1.1 ± 0.0  1.3 ±0.1 GOSCMOS High Fat & Prebio1  1.1 ± 0.0  1.2 ± 0.1 High fat & lactose 1.1 ± 0.0  1.4 ± 0.1 Acyl.carnitine Low Fat control 93.3 ± 26   95.7 ±21.4 High fat control   108 ± 15.3 112.4 ± 13.8 High fat & GOS  84.8 ±11.6 88.9 ± 11  High fat &   126 ± 15.9 109.2 ± 17.3 GOSCMOS High Fat &Prebio1  96.2 ± 28.1 108.3 ± 29.8 High fat & lactose   105 ± 14.8 112.2± 16.1 Carnitine Low Fat control 101.8 ± 18.6 110.4 ± 16   High fatcontrol 115.9 ± 14.1 130.9 ± 17.9 High fat & GOS 102.1 ± 13.4 122.9 ±13.6 High fat & 226.2 ± 33.3 293.6 ± 39.4 GOSCMOS High Fat & Prebio1101.7 ± 9.6    127 ± 13.6 High fat & lactose 119.7 ± 8.6  132.2 ± 14.1Creatinine Low Fat control 104.4 ± 18.7 118.5 ± 19.5 High fat control100.3 ± 17.4 131.4 ± 27.3 High fat & GOS  86.8 ± 24.1 109.8 ± 30.9 Highfat &  87.1 ± 10.8  93.1 ± 15.1 GOSCMOS High Fat & Prebio1  91.6 ± 10.9107.6 ± 17.1 High fat & lactose 106.2 ± 16   125.4 ± 18   IndoxylsulfateLow Fat control 99.6 ± 26  119.8 ± 34.6 High fat control  96.1 ± 23.7118.3 ± 49.8 High fat & GOS 46.7 ± 9.4  56.1 ± 11.4 High fat &  50.8 ±12.1  48.9 ± 10.6 GOSCMOS High Fat & Prebio1  54.6 ± 16.8   68 ± 21.7High fat & lactose  86.7 ± 23.9   99 ± 32.3 Isovaleryl- Low Fat control105.4 ± 18.8 106.8 ± 42.5 glycine High fat control   128 ± 30.4 131.3 ±38.2 High fat & GOS 118.2 ± 28.2 143.5 ± 45.2 High fat & 116.5 ± 16.5116.1 ± 18.3 GOSCMOS High Fat & Prebio1 129.1 ± 28.6 137.7 ± 24.4 Highfat & lactose 130.2 ± 24.2 125.7 ± 25.8 Oxaloacetate Low Fat control101.1 ± 24.7 111.9 ± 19.4 High fat control 103.2 ± 18.4 120.7 ± 30.7High fat & GOS 66.2 ± 7.6 68.8 ± 7.7 High fat & 64.6 ± 8.4 59.3 ± 7.9GOSCMOS High Fat & Prebio1  69.5 ± 12.5 71.9 ± 13  High fat & lactose 95.2 ± 14.7 102.3 ± 17.5 Phenylacetyl- Low Fat control 107.2 ± 20.2128.9 ± 34.8 glycine High fat control  77.7 ± 15.6 102.3 ± 28.5 High fat& GOS 41.8 ± 8.6  82.7 ± 36.4 High fat &  42.5 ± 10.3  55.2 ± 17.7GOSCMOS High Fat & Prebio1  50.4 ± 23.3  69.3 ± 27.6 High fat & lactose72.4 ± 15   91.5 ± 14.8 Tartrate Low Fat control  94.6 ± 36.3   114 ±72.8 High fat control 123.1 ± 40.3 172.4 ± 104  High fat & GOS   117 ±60.8 117.4 ± 84.3 High fat &  95.3 ± 38.1 111.2 ± 46.9 GOSCMOS High Fat& Prebio1   123 ± 111.7  139.7 ± 103.4 High fat & lactose 115.3 ± 52  150.5 ± 62.9 Taurine Low Fat control  90.8 ± 24.6 117.1 ± 69.1 High fatcontrol  81.9 ± 39.6  72.6 ± 33.2 High fat & GOS  93.1 ± 45.4  75.1 ±46.1 High fat &  86.1 ± 45.9  89.4 ± 46.3 GOSCMOS High Fat & Prebio1127.3 ± 53.6 104.6 ± 40.5 High fat & lactose 120.8 ± 68.1 129.9 ± 87.8Trimethyl- Low Fat control  134.1 ± 138.4  160.6 ± 170.9 amine High fatcontrol 45.6 ± 35   44.5 ± 38.4 (TMA) High fat & GOS  37.8 ± 23.9 39.7 ±23  High fat & 118.7 ± 78.7 125.5 ± 57.9 GOSCMOS High Fat & Prebio1 94.5 ± 74.4   106 ± 122.4 High fat & lactose  62.6 ± 53.5  51.6 ± 38.1Trimethyl Low Fat control  83.7 ± 34.8 122.2 ± 73.2 amine- High fatcontrol  80.1 ± 40.1  72.5 ± 31.4 N-Oxide High fat & GOS  79.3 ± 41.1 74.3 ± 36.8 (TMAO) High fat &  82.4 ± 39.9 110.6 ± 58.7 GOSCMOS HighFat & Prebio1 101.2 ± 39.3  94.4 ± 43.3 High fat & lactose 101.4 ± 50.7 98.5 ± 44.6 Alpha- Low Fat control 106.8 ± 10.3 94.8 ± 15  ketoiso-High fat control 150.4 ± 26.1 119.7 ± 20.7 valerate High fat & GOS 124.1± 20.6 124.4 ± 21   High fat &   132 ± 14.3   120 ± 17.3 GOSCMOS HighFat & Prebio1   126 ± 23.9 125.1 ± 18.1 High fat & lactose 147.6 ± 15.7126.8 ± 13.7

1. A method for predicting and/or quantifying the response of a subjectto prebiotics in the prevention of diet induced weight gain, comprisinga) determining a level of indoxyl sulfate in a urine sample obtainedfrom a subject that has consumed prebiotics, and b) comparing thesubject's indoxyl sulfate level to a predetermined reference value,wherein a decreased indoxyl sulfate level, or an absence of change inthe indoxyl sulfate level, in the urine sample compared to thepredetermined reference value indicates that the administration ofprebiotics is effective in the prevention of diet induced weight gain inthe subject.
 2. The method of claim 1, wherein the diet is a high fatdiet.
 3. The method of claim 1, further comprising the steps of a)determining the level of at least one further biomarker selected fromthe group consisting of oxaloacetate, creatinine, trimethylamine, andalpha-keto-isovalerate in the urine sample, and b) comparing thesubject's level of the at least one further biomarker to a predeterminedreference value, wherein: (i) a decreased oxaloacetate, creatinine,and/or alpha-keto-isovalerate level, or an absence of change in theoxaloacetate, creatinine, and/or alpha-keto-isovalerate level, in theurine sample; and/or (ii) an increased trimethylamine level, or anabsence of change in the trimethylamine level, in the urine sample;compared to the predetermined reference values indicates that theadministration of prebiotics will be effective in the prevention of dietinduced weight gain in the subject.
 4. The method according to claim 1,wherein the levels of the biomarkers in the urine sample are determinedby ¹H-NMR and/or mass spectrometry.
 5. The method according to claim 1,wherein the predetermined reference value is based on an average indoxylsulfate level in urine in a control population of subjects consuming ahigh fat diet.
 6. The method according to claim 1, wherein thepredetermined reference value is the indoxyl sulfate level in urine inthe subject before the prebiotics were consumed.
 7. The method accordingto claim 1, wherein the level of indoxyl sulfate and/or the furtherbiomarkers are determined in a urine sample obtained from the subjectafter at least three consecutive days of prebiotic consumption.
 8. Themethod according to claim 1, wherein the prebiotic is selected from thegroup consisting of oligosaccharides, optionally containing fructose,galactose, mannose; dietary fibers, in particular soluble fibers, soyfibers; inulin; or mixtures thereof.
 9. The method according to claim 8,wherein the prebiotics are selected from the group consisting offructo-oligosaccharides (FOS); galacto-oligosaccharides (GOS);isomalto-oligosaccharides; xylo-oligosaccharides; bovine milkoligosaccharides (BMOS); glycosylsucrose (GS); lactosucrose (LS);lactulose (LA); palatinose-oligosaccharides (PAO);malto-oligosaccharides (MOS); gums and/or hydrolysates thereof; pectinsand/or hydrolysates thereof; and combinations thereof.
 10. The method ofclaim 9, wherein the prebiotics comprise (a) galactooligosaccharides(GOS) (b) bovine milk oligosaccharides (BMOS) or (c) inulin andfructooligosaccharides (FOS).
 11. The method of claim 10, wherein thebovine milk oligosaccharides (BMOS) comprise cow's milkoligosaccharides-galactooligosaccharides (CMOS-GOS).
 12. The methodaccording to claim 1, wherein the subject has consumed the prebiotics inan amount of at least 2 g/day.
 13. The method according to claim 1,wherein the subject is a mammal such as a human; a non-human species,including a primate; a livestock animal such as a sheep, a cow, a pig, ahorse, a donkey, or a goat; a laboratory test animals such as mice,rats, rabbits, guinea pigs, or hamsters; or a companion animal such as adog or a cat.
 14. The method according to claim 1, wherein the method isused to devise a stratified diet for a group of subjects or apersonalized diet for the subject.
 15. A method for preventingdiet-induced weight gain in a subject, comprising: a) performing amethod as described in claim 1; and b) administering prebiotics to thesubject if the level of indoxyl sulfate in the urine sample is decreasedor unchanged compared to the predetermined reference value.
 16. A methodaccording to claim 15, wherein administration of prebiotics to thesubject is continued for at least one month.
 17. A method according toclaim 15, wherein if the level of indoxyl sulfate in the urine sample isincreased compared to the predetermined reference sample, prebiotics arenot administered to the subject.
 18. A method according to claim 17,wherein an alternative treatment for weight gain prevention is providedto the subject, the treatment selected from calorie restriction, dietaryfat intake reduction, a non-prebiotic weight loss product, or anexercise program.
 19. A biomarker in urine for predicting and/orquantifying the response of subjects to prebiotics in the prevention ofdiet induced weight gain, wherein the biomarker is indoxyl sulfate. 20.(canceled)